Kimura Yoshitaka, Suzuki Nobuaki, Sugawara Jun-Ichi, Murakami Takashi, Terada Yukihiro, Chisaka Hiroshi, Okamura Kunihiro
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan.
Fetal Diagn Ther. 2004 May-Jun;19(3):278-85. doi: 10.1159/000076712.
In twin pregnancies, it has been suggested that fluctuations of the two fetal heart rates should be considered as two variates that affect each other. We therefore investigated whether the relative power contribution (RPC) of heart rate fluctuation between twins reflects the clinical severity of twin-to-twin transfusion syndrome.
Sixty-three cases of twin pregnancy including 43 monochorionic twins and 20 dichorionic twins were studied. Thirteen monochorionic twins with polyhydramnios in one twin were regarded as twin-to-twin transfusion syndrome (TTTS). Of the 13 TTTS cases, 8 cases with polyhydramnios in one twin and oligohydramnios in the other were deemed to be a 'stuck' twin. The RPC of the very low frequency domain (VL; 0.0125-0.0625 Hz) of fetal heart rate fluctuation in the twin fetuses of monochorionic and dichorionic pregnancies was obtained within a week of delivery. The relationship between the value of the RPC and the outcome of these twins was examined.
For both monochorionic and dichorionic twins the RPC of twin fetuses was significantly higher in TTTS twins than in twins without TTTS. In particular, in pregnancies that resulted in fetal death, early neonatal death, or hydrops of one of the twins, this twin had a higher RPC than the other twin. No significant difference was observed in the RPC value between twins of either monochorionic or dichorionic pregnancies that did not develop TTTS. Serial changes in RPC values were followed in 7 cases of TTTS. The RPC value rose rapidly just before delivery in three cases with resultant poor outcome.
A rapid change in the RPC of twin fetuses measured using the VL frequency domain of fetal heart rate fluctuations may predict poor outcome in twin pregnancies.
在双胎妊娠中，有人提出两个胎儿心率的波动应被视为相互影响的两个变量。因此，我们研究了双胎之间心率波动的相对功率贡献（RPC）是否反映双胎输血综合征的临床严重程度。
对63例双胎妊娠进行了研究，其中包括43例单绒毛膜双胎和20例双绒毛膜双胎。13例单绒毛膜双胎中，一胎羊水过多的被视为双胎输血综合征（TTTS）。在这13例TTTS病例中，8例一胎羊水过多而另一胎羊水过少的被认为是“黏连”双胎。在分娩前一周内获取单绒毛膜和双绒毛膜妊娠双胎胎儿心率波动的极低频域（VL；0.0125 - 0.0625 Hz）的RPC。检查RPC值与这些双胎结局之间的关系。
对于单绒毛膜和双绒毛膜双胎，TTTS双胎胎儿的RPC均显著高于无TTTS的双胎。特别是，在导致胎儿死亡、早期新生儿死亡或其中一个双胎发生水肿的妊娠中，该双胎的RPC高于另一个双胎。未发生TTTS的单绒毛膜或双绒毛膜妊娠双胎之间的RPC值未观察到显著差异。对7例TTTS病例的RPC值进行了连续变化跟踪。在3例结局不佳的病例中，RPC值在分娩前迅速上升。
使用胎儿心率波动的VL频域测量的双胎胎儿RPC的快速变化可能预测双胎妊娠的不良结局。
